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Evaluation of a Weight‐Based Heparin Dosing Protocol
Author(s) -
Slader Simon AA,
Welch Susan A,
Finckh Andrew,
Brien Joanne E
Publication year - 2005
Publication title -
journal of pharmacy practice and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.222
H-Index - 22
eISSN - 2055-2335
pISSN - 1445-937X
DOI - 10.1002/j.2055-2335.2005.tb00293.x
Subject(s) - medicine , partial thromboplastin time , heparin , dosing , myocardial infarction , anesthesia , low molecular weight heparin , unstable angina , angina , coronary care unit , emergency medicine , surgery , platelet
Aim To describe the anticoagulant effect, as assessed by initial activated partial thromboplastin time (APTT) results and time taken to reach the target APTT range, using a weight‐based heparin protocol. A secondary aim was to assess the level of concordance with the protocol. Method Records of 50 patients admitted to the coronary care unit via the emergency department during a relevant 2‐month period with a preliminary diagnosis of unstable angina, myocardial infarction, chest pain or ischaemic heart disease and commenced on intravenous heparin, were retrospectively reviewed. Results The initial APTT was documented for 98% (49/50) of patients. The proportion of initial APTTs > 100 seconds was 12% (6/49). Initial APTTs were within the therapeutic range (60–85 seconds) for 27% (13/49) of patients. The initial APTT was subtherapeutic (< 60 seconds) in 47% (23/49) of patients. The median time to a therapeutic APTT was 12.2 hours and the median time to the first measurement of APTT was 7.3 hours. The heparin order documented on the medication chart was concordant with the protocol 36% (18/50) of the time. There was no patient weight recorded on the medication chart 28% (14/50) of the time, and an incorrect starting heparin rate prescribed 18% (9/50) of the time. The desired APTT range was specified in 74% (37/50) of records reviewed. Overall, the rate was adjusted according to the protocol 70% (35/50) of the time. Conclusion The evaluation of application of the weight‐based heparin protocol has identified opportunities for practice improvement. Subsequent interventions include linking heparin prescribing protocol details with the existing electronic information systems at the point‐of ‐care.